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digoxin

digoxin
  • Restricted Medications IV Push
Drug Name Form Strength Non-Formulary Restricted TX Sub Notes
Lanoxin SOLUTION, INJECTABLE 100 mcg/mL (0.1 mg/mL)      
Lanoxin TABLET, ORAL 125 mcg (0.125 mg)      
Display Cardiotonic Agents Class : 240408
High Alert Drug : Policy
Medication comments:

Digoxin requires the following prior to each administered dose:
1) Nursing staff shall obtain the patient’s apical heart rate and record in the EMR.
2) If the apical heart rate is less than 50, the nurse shall hold the dose and notify the provider for further orders.
3) This is applicable to all routes of administration.
High Alert Drug: IV inotropic medications
 • Special instructions on MAR to check HR prior to administration.
 • Two RNs independently verify dose prior to administration.
Per policy, these medications require cardiac and/or special monitoring.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes CCU, OR, PACU, CCL, ED PCU 2N (Tele) 1N (Tele), 3N (Tele) Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) BirthPlace SNF ICS OPS
digoxin (Lanoxin)
IV Push		 Y Y Y Y N N N N N
Per policy, orders for these non-formulary agents will be changed to formulary equivalents.  
Non-Formulary Agent Formulary Equivalent
digoxin (Lanoxin) 0.1 mg cap digoxin (Lanoxin) 0.125 mg tab
digoxin (Lanoxin) 0.2 mg cap digoxin (Lanoxin) 0.25 mg tab
Per policy, these hazardous drugs have special waste requirements. 
Generic (Brand) Waste Requirements
digoxin (Lanoxin) Injection contains alcohol ⇒  BLACK BUCKET 
Adult Extravasation Management
digoxin (Digitek, Digox, Lanoxin)
Agent type: Non-Chemotherapeutic
Vesicant/Irritant: Vesicant
Local Care: None
Antidote: None
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
digoxin
(Lanoxin)		 High-fiber containing meals may reduce oral bioavailability Separate from fiber-containing tube feeds, otherwise no need to hold beyond flush-administer-flush
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: digoxin (Lanoxin)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Comments for first-line treatment of atrial fibrillation or heart failure
Drug(s) digoxin
Rationale Use in atrial fibrillation: should not be used as a first-line agent because there are safer and more effective alternatives for rate control.
Use in heart failure: evidence for benefits and harms of digoxin is conflicting and of lower quality; most (but not all) evidence concerns use in HFrEF. There is strong evidence for other agents as firstline therapy to reduce hospitalizations and mortality in adults with HFrEF. In heart failure, higher dosages are not associated with additional benefits and may increase the risk of toxicity. Use caution in discontinuing digoxin among current users with HFrEF, given limited evidence suggesting worse clinical outcomes after discontinuation.
Decreased renal clearance of digoxin may lead to an increased risk of toxic effects; further dose reduction may be necessary for those with Stage 4 or 5 chronic kidney disease.
Recommendation Avoid this rate control agent as first-line therapy for atrial fibrillation.
Avoid as first-line therapy for heart failure. See rationale for caution about withdrawal in long-term users with HFrEF.
If used for atrial fibrillation or heart failure, avoid dosages >0.125 mg/day.
 Quality of evidence: Atrial fibrillation; heart failure: low
Dosage > 0.125 mg/day: moderate, Strength of Recommendation: Strong
Last updated: Mar. 14, 2026
  • Hazardous Waste BLACK BUCKET
UpToDate Lexidrug

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